Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Behavioral Health Care Manager I Job Description: Behavioral Health Care Manager I Carelon, a proud member of the Elevance Health family of companies, is a healthcare serv…
Skills: Utilization Management, Clinical Judgment, Case Planning, Psychiatric Assessment, Substance Abuse Treatment
Atlanta, Georgia, United States · Hybrid
$145k–$218k/yr
Anticipated End Date: 2026-07-17 Position Title: Release Management Executive Advisor Job Description: Release Management Executive Advisor Location: This role requires associates to be in-office 3 days per week, fosteri…
Skills: Release Planning, SDLC, Project Management, Risk Management, Change Management
Nashville, Tennessee, United States · Hybrid
Anticipated End Date: 2026-07-31 Position Title: Head of Clinical Production Operations and Strategy Job Description: Head of Clinical Production Operations and Strategy Location: This role enables associates to work vir…
Skills: Production Planning, Capacity Planning, Strategic Planning, Workforce Management, Financial Modeling
Miami, Florida, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Utilization Management Representative I (Miami, FL) Job Description: Utilization Management Representative I Virtual: This role enables associates to work virtually full-t…
Skills: Case Coordination, Precertification, Prior Authorization, Medical Terminology, Customer Service
Lake Mary, Florida, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Utilization Management Representative I Job Description: Utilization Management Representative I Location: This role enables associates to work virtually full-time, except…
Skills: Case Coordination, Precertification, Prior Authorization, Customer Service, Medical Terminology
Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Business Analyst III- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims Job Description: Title: Business Analyst III Location: Indianapolis, IN Hybrid T…
Skills: Data Mining, Business Analysis, Payment Integrity, Claims Processing, Advanced Excel
Iselin, New Jersey, United States · Hybrid
$168k–$169k/yr
Anticipated End Date: 2026-08-24 Position Title: Data Admin Analyst Senior Job Description: Data Admin Analyst Senior Location: Ideal candidates will be able to report to our Pulse Point location at 111 Wood Ave S., Suit…
Skills: Data Modeling, Data Engineering, SQL, NoSQL, Python
Grand Prairie, Texas, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Engineer Senior Job Description: Engineer Senior Location: Ideal candidates will be able to report to our Pulse Point location at 2505 N Hwy 360, Suite 300, Grand Prairie,…
Skills: AWS, Azure, Apache Spark, Python, SQL
Grand Prairie, Texas, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Engineer III Job Description: Engineer III Location: Ideal candidates will be able to report to our Pulse Point location at 2505 N. Highway 360, Suite 300, Grand Prairie, …
Skills: Terraform, AWS, Ansible, Packer, Jenkins Cloudbees
Iselin, New Jersey, United States · Hybrid
$151k–$152k/yr
Anticipated End Date: 2026-08-24 Position Title: Systems Analyst Advisor Job Description: Systems Analyst Advisor Location: Ideal candidates will be able to report to our Pulse Point location at 111 S Wood Ave, Ste 220, …
Skills: AWS, SQL, Data Modeling, Master Data Management, Informatica
Norfolk, Virginia, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Engineer Lead Job Description: Engineer Lead Location: Ideal candidates will be able to report to our Pulse Point location at 5800 Northampton Blvd., Norfolk, VA 23502. Th…
Skills: Pega PRPC, CSR/CPM Framework, Constellation, .NET, Unix Shell Script
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Engineer Senior Job Description: Engineer Senior Location: Ideal candidates will be able to report to our Pulse Point location at 740 W. Peachtree St NW, Atlanta, GA 30308…
Skills: NodeJS, Python, Linux, SQL, Redis Cache
Grand Prairie, Texas, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Engineer Senior Job Description: Engineer Senior Location: Ideal candidates will be able to report to our Pulse Point location at 2505 N. Highway 360, Suite 300, Grand Pra…
Skills: AWS Security, CI/CD, DevOps, EC2, S3
Atlanta, Georgia, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Business Analyst II- Data Mining Overpayment and Operations/Payment Integrity-WGS Commercial Claims Job Description: Business Analyst II – Commercial Claims Data Mining Sh…
Skills: Data Mining, Business Analysis, Claims Validation, UAT Testing, MS Excel
Indianapolis, Indiana, United States · Hybrid
Anticipated End Date: 2026-07-17 Position Title: Business Consultant Sr- Data Mining Overpayment and Operations/Payment Integrity- WGS Claims Job Description: Business Consultant Sr Location: Indianapolis, IN Hybrid This…
Skills: Machine Learning, Business Analysis, Project Management, Data Mining, MS Excel
Greenville, South Carolina, United States · On-site
Anticipated End Date: 2026-09-10 Position Title: Pharmacy Technician II – Fulfillment -BioPlus Specialty Pharmacy Job Description: Pharmacy Technician II – Fulfillment Location: SC-GREENVILLE, 1325 MILLER RD, STE K Onsit…
Skills: Prescription Preparation, Medication Labeling, Inventory Control, Pharmacy Adjudication, Regulatory Compliance
Chicago, Illinois, United States · Hybrid
$164k–$165k/yr
Anticipated End Date: 2026-08-24 Position Title: Business Info Developer Consultant Sr Job Description: Business Information Developer Consultant Senior Location: Ideal candidates will be able to report to our Pulse Poin…
Skills: Data Warehousing, Database Management, SQL Server, ETL SSIS, AWS Cloud
Mason, Ohio, United States · Hybrid
Anticipated End Date: 2026-08-24 Position Title: Engineer III Job Description: Engineer III Location: Ideal candidates will be able to report to our Pulse Point location at 4361 Irwin Simpson Rd, Mason, OH 45040. This ro…
Skills: Java 11/J2EE, Cloud Native Design Patterns, Terraform, DevOps, Spring Boot
Norfolk, Virginia, United States · Hybrid
$125k–$126k/yr
Anticipated End Date: 2026-08-24 Position Title: Engineer III Job Description: Engineer III Location: Ideal candidates will be able to report to our Pulse Point location at 5800 Northampton Blvd., Norfolk, VA 23502. This…
Skills: Java, J2EE, Drools, Hibernate, Spring
Norfolk, Virginia, United States · Hybrid
$151k–$152k/yr
Anticipated End Date: 2026-08-24 Position Title: Engineer Senior Job Description: Engineer Senior Location: Ideal candidates will be able to report to our Pulse Point location at 5800 Northampton Blvd., Norfolk, VA 23502…
Skills: Sql Server, Oracle Soap, Postman, Ms Visio, Jira
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
Manage psychiatric and substance abuse treatment benefits through telephonic or written reviews. Assess member needs using clinical guidelines to ensure access to medically necessary and cost-effective behavioral healthcare.
Requires a postgraduate degree in social work, counseling, or nursing with at least 3 years of experience in psychiatric or substance abuse treatment. Must hold a current, unrestricted professional license (e.g., RN, LCSW, LPC, LMFT) to practice in Georgia.
Carelon, a proud member of the Elevance Health family of companies, is a healthcare services organization that takes a whole-health approach to making care more integrated, personalized, and affordable. We put people at the center—connecting physical, behavioral, social, and pharmacy services, along with clinical expertise, research, operations, and advanced technology to help care work better, together.
Among us are specialty-care physicians, nurse practitioners, pharmacists, engineers, data scientists, and other dedicated and caring health professionals. While our roles may differ, our purpose is shared: to make a positive impact on whole health.
Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note, the team does meet once a quarter in person for team meetings.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.
The Behavioral Health Care Manager I will be responsible for managing psychiatric and substance abuse or substance abuse disorder facility-based and outpatient professional treatment health benefits through telephonic or written review.
Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract.
Refers cases to Peer Reviewers as appropriate.
Performs psychiatric and substance abuse or substance abuse disorder assessment coordination implementation case planning monitoring and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.
Minimum Requirements:
Requires MA/MS in social work counseling or a related behavioral health field or a degree in nursing, and minimum of 3 years of experience with facility-based and/or outpatient psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience which would provide an equivalent background.
Current active unrestricted license, such as RN LCSW LPC (as allowed by applicable state laws) LMFT or Clinical Psychologist to practice as a health professional within the scope of licensure in in the state of Georgia required.
Licensure is a requirement for this position.
Previous experience in utilization management with a broad range of experience with complex psychiatric/substance abuse cases preferred.
For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner. Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health. We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.
Offices: 220 Virginia Ave, Indianapolis, Indiana 46204, US
